He was charged following a lengthy investigation by police at Stepping Hill Hospital in Stockport, where he worked.

The 34 offences he is alleged to have committed are three murders, one charge of causing grievous bodily harm with intent, 22 counts of attempting to cause grievous bodily harm with intent, seven charges of attempting to administer poison and one count of causing poison to be administered with intent.

Diminutive Chua, a Filipino, wearing a Gap camouflage coloured hoodie, was dwarfed by the prison officer flanking him in the dock.

The father-of-two replied "Yes Mam" to the clerk who told him he faces a total of 34 charges, including the murders of Tracey Arden, 44, Arnold Lancaster, 71 and Derek Weaver, 83.

As the charges are so serious, the case and any bail application can only be dealt with at the crown court, the defendant was told.

Ben Southam, prosecuting, asked for the case to be listed for a bail and preliminary hearing next week.

Chua was remanded into custody to appear at Manchester Crown Court next Tuesday.

Kevin Phillips, chairman of the bench, told Chua: "We will remand you into custody and send to crown court for a bail and preliminary hearing."

Chua, of Churchill Street, Stockport, replied: "Yes sir. Thank you sir," before being handcuffed and led from the dock back to the cells.

All the alleged offences span a six-month period between June 1 2011 and January 3 2012, when patients where Chua worked at Stepping Hill were poisoned.

The alleged murders of Ms Arden, Mr Lancaster and Mr Weaver took place within a 14-day period, on July 7, 11 and 21 in 2011.

Chua was first held in January 2012, and has been on bail since then, but was re-arrested and charged yesterday.

Ann Barnes, chief executive of Stockport NHS Foundation Trust, which runs Stepping Hill Hospital, said: "We are very much aware that at the centre of this complex and lengthy police investigation are the patients and their families affected by these events.

"Our thoughts have been with them throughout this time.

"We are grateful for the continued support from all the communities we serve. We have always benefited from outstanding public support and confidence in our services and are pleased that this has never wavered.

"Our hospital has a strong track record and good reputation and people clearly recognise this.

"We would like to recognise and thank the staff for showing great professionalism throughout the police investigation.

"We have always had an excellent safety record and are ranked as one of the best hospitals in the country by the Care Quality Commission.

"We have worked closely with the police throughout the investigation and will continue to provide any support required.